LSHA Call for Papers 2021
Thank you for your interest in presenting at our Virtual LSHA Convention 2021! Please complete the following form by April 15. If you are selected to present, we will contact you by April 19. Please be advised that in most cases, we are unable to compensate our speakers. Please email
office@lsha.org
or
jafornadley@gmail.com
with any questions.
* Required
Primary author name & credentials
*
Your answer
Email address
*
Your answer
Format
*
Presentation/lecture (1+ hours)
Roundtable discussion/panel (1+ hours)
Short lecture/poster presentation (10-20 minutes)
Duration
*
10 minutes
20 minutes
1 hour
1.5 hours
2 hours
3 hours
Other:
Course title
*
Your answer
Content area(s) (select all that apply)
*
Medical
Schools
Audiology
Adults
Peds
Advocacy
Ethics
Supervision
Other:
Required
Please indicate date(s) you are available to present.
*
Thursday, June 3
Friday, June 4
Saturday, June 5
Required
If you have presented this lecture before, please indicate when and where.
Your answer
Biographical sketch of the primary author (50 words or less)
*
Your answer
Are there multiple authors?
*
Yes
No
If there are multiple authors, please provide the following information: Name & credentials, email, and brief biographical sketch.
Your answer
Proposal abstract
*
Your answer
Learner objective 1
*
Your answer
Learner objective 2
*
Your answer
Learner objective 3
*
Your answer
Are you in compliance with HIPAA requirements?
*
Yes
No
Do you have a relevant financial relationship to disclose? If yes, please describe the financial relationship.
*
Your answer
Do you have a relevant non-financial relationship to disclose? If yes, please describe the non-financial relationships.
*
Your answer
E-signature for disclosure
*
Your answer
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